Provider Demographics
NPI:1578540357
Name:SHEN, KATHERINE ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANNE
Last Name:SHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ANNE
Other - Last Name:RING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2611 LOCKHART RD
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5417
Mailing Address - Country:US
Mailing Address - Phone:801-272-5325
Mailing Address - Fax:
Practice Address - Street 1:4745 S 3200 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-2822
Practice Address - Country:US
Practice Address - Phone:801-964-6214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT327583-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine